HomeMy WebLinkAboutBuilding Permit Application 0 7)�
ALL APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED St. Lucie County
Date: _0?`�' U. Permit NuppoefiSI I �
Date: I
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Building PermiA�i�'�' okc � Au1r
Planning and Development Services FORDABLE ATT ABLE
Building and Code Regulation Division WORKFORCE HQ SING
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROPOS`ED IIViPROVEMENT LC}CATItN
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Address: I `i2 a '� �O T _!:�5k I au e
Legal Description:_ 1\Qb2,_, n,�� ►
Property Tax ID##:`SCI 19 --- 53 0 —104 322— OM-0 Lot No.
Site Plan Name: Block No.�
Project Name:
Setbacks Front Back: Right Side: Left Side:
1, D�TAILEp DESCRIPTION
P F t I .S, ,,t
CQNSTRUCTIQN INFORMATION
Additional work to-be—Derformed under this permit—c ec a a y:
HVAC ,Gas Tank Gas Piping _Shutters lows /Doors
Electric F] Plumbing Sprinklers OGenerator D C� Roof pitch
Total Sq.Ft of Construction:
So.Ft.of First Floor:
Cost of Construction:$ I l` Utilities: Sewer Septic Building Height:
01J1lNI:RJLES�SE CONTRACTOR
Name Iz� `o Name { C .`2 �►Z CS i2
Address: s) 1;2 A Company• 6 e folzt�
City: 6' 2_ Wile State:l�_ Address:a k P
Zip Code:?5�01_$5 Fax: City: k t ° A Qi Stater
Phone No. i :9Zip Code:�:.. Fax: _
E-Mail: Phone No.CL 60 _
Fill in fee simple Title Holder on neat page'(if different E-Mail: •�r=�I-I;-1.�I( r b&4 &b�0
from the Owner listed above) State or County License: � ),�., c_ 1 Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
STRUCTIC?N LIEN LAW INRMATl4N
FO
At�C-47
DESIGNER/ENGINEER; T Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address-, Address:
City: State:— City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY- Not Applicable
Name, Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no-representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result In your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Sign re W?0w_nbr/Lqfssee JCantra asAgent for Owner SignaWe of Contract r
Lacense4Wder-,'
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF &"V-
The forp rjdment was acknowledged &. I
�ing intra nowledged before me The forWing instrument was acknowledged before me
thist,-,e
.0 —day of FebvR- I-by
20 thisg+&kday of Pfiarvaw�4, 20 J-7—by
(Name of person acknowledging) (Name of person acknowledging)'
VIC
(Signature of Notary Public-State of Florida) (Signature of Notary Public-state of Florida
Personally Known Y ersonally Known OR Produced identification
Type of Identification Prod MA DE LA LUZ VELA C I Vpe of identification Produ cl
MY COMMISSION#GGQW3
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Commission No. EONS November 23. (ommission No. M4
EXPIRES November 28.20
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE `-
INITIALS